The Gradual Evolving Process In The Pathophysiology Of Polycystic Ovarian Syndrome

Objective:As a mismatch existing in the pathophysiology and treatment of polycystic ovarian syndrome (PCOS), this study analyze the clinical features, endocrine and metabolic characteristics in the different groups of women with PCOS patients to explore the evolution of the pathophysiology of PCOS, and come up with a new understanding of the TCM syndrome in PCOS. These may benefit for the comprehensive treatment of PCOS and improve the clinical efficacy.Methods:Part one:758 clinic cases of PCOS were collected in the second People’s Hospital of Hunan Province from the October in 2009 to the November in 2010. they were divided to different groups respectively according to the results of hormone levels, OGTT, insulin and C peptide release test, then compared, analyzed and summarized the characteristics of hormone levels and metabolic of the patients with PCOS.Part two:According to the current researches of PCOS, this paper discussed various aspects from pathogenesis, pathophysiology, clinical manifestations, diagnostic criteria, clinical treatment, prognosis, and so on. And analyzed the symptom features of Traditional Chinese Medicine presented in the PCOS patients, proposed a new understanding to PCOS Syndrome DifferentiationResults:Part one:Insulin resistance in adolescent PCOS was more pronounced than the reproductive age, Their postprandial 0.5h, 1h,2h,3h insulin were significantly higher than the other(P<0.05),the same as HBCI and IAUC. LH, LH/FSH, T in the high androgen(HA) group was higher than the non-high androgen group, the difference was significant (P<0.001) Postprandial 0.5h, 1h glucose and insulin in HA group were significantly higher than the other(P<0.05). And so was the IAUC. But there were no significant difference between two groups in C peptide, HOMA-IR, ISI, HBCI, GAUC(P>0.05). FSH, LH level in Insulin resistance group were less than non-insulin-resistant group, the difference were statistically significant (P<0.05), while there were no difference among LH/FSH, E and T (P>0.05).The incidence of obese, overweight, DM, IGT in the insulin resistant group were higher than the non-insulin resistant group, the Fasting and postprandial of glucose, insulin, C peptide and HOMA-IR, HBCI, GAUC, IAUC were all higher than non-insulin resistant group, showing statistically significant difference (P<0.001).The incidence of obesity, insulin resistance, hyperandrogenism in DM group were significantly higher than the other two groups (P<0.001), The BMI, T, and IR, GAUC, IAUC in the DM and the IGR group were higher than the normal group, while the ISI in the DM group was the lowest in the three groups.Part two:PCOS is a kind of multiple system disease, the pathogens is possibly relative to heredity, environment, living habits and so on. Its cli-nical manifestations are diverse and pathophysiological process is contin-uous seriously,even it may develop to long-term complications, such as diabetes, cardiovascular disease and so on, which threaten the PCOS patients’ health. However, the therapy of using hormone and ovulation drugs is still considerable. Chinese medicine treatment is effective to PC OS, but its symptoms are various, so TCM syndrome differentiation is worth to discuss.Conclusions:1 Insulin resistance exists in adolescent PCOS, and it is more obvious than the reproductive age. Part of the adolescent PCOS had occurred abnormal glucose metabolism.Therefore, we should pay more attention to their glucose metabolism whatever in the diagnosis and treatment of adolescent PCOS.2 The combination of hyperinsulinemia and high luteinizing hormone (LH) lead to hyperandrogenism, LH in high hyperandrogenism group is higher than non hyperandrogenism group.3 The incidence of insulin resistance and hyperinsulinemia are higher than the abnormal glucose metabolism in PCOS patients, meanwhile PCOS patients with Obesity will aggravate the HI and IR, so pay more attention to insulin function earlier and provide early intervention to prevent the occurrence of diabetes. Insulin, C peptide release test can reflect islet function earlier than OGTT. Thus, OGTT, IRT+C-p should be combined to measure PCOS patients4 PCOS is a disease involving multiple systems, which has complex pathophysiology and continued to change constantly. Low estrogen and high androgen status is not conducive to follicular development. The pathophysiological process of PCOS is a complicated evolution process from endocrine disorders/multiple cystic changes (PCO)â†'hyperin-sulinemia(HI)â†'insulin resistance (IR)â†'impaired glucose tolerance (IGT)/metabolic syndrome(MS)â†'diabetes mellitus(DM).